The munich sleep endoscopy protocoll (MSEP)

Introduction: Before performing surgery in patients with obstructive sleep apnea a drug induced sleep endoscopy (DISE) should be done. DISE is useful to identify the location and pattern of upper airway obstructions. The aim of the study was to investigate, if the depth of anesthesia has an influence on the degree of obstruction and the occurrence of different patterns of the upper airway. Methods: 20 patients with obstructive sleep apnea (CPAP incompliant), which decided to have surgery, underwent a DISE. For DISE propofol was infused via target controlled infusion pump (TCI). The depth of anesthesia was measured by spectral entropy. The degree of obstruction and the occurrence of different patterns of the upper airway were measured with VOTE-classification for velum, oropharynx lateral walls, tongue base and epiglottis during light, medium and deep sedation. Results: No significant changes in the degree of obstruction and obstruction pattern were observed with an increasing sedation. Conclusion: With increasing depth of sedation, associated with an increase in propofol, there have been no significant changes in the pattern of obstruction. A change in obstruction places (from cranial to caudal) was detected between light and medium depth of sedation in 2 patients. Furthermore in these 2 patients the collapse changed from anterior-posterior to a concentric collapse.